(spoiler alert: M stands for mother#^@%*&)

Women (and men!) often ask me…just what is menopause? My snarky response: menopause is the devil, mainly because I am not a fan of heat (or change for that matter…). However, my gynecologist-self’s response is a little more robust. In this blog I will focus on providing a working understanding of menopause and how it affects our bodies. First, here are some facts:

• Menopause is defined as the final menstrual period and is confirmed after 1 year of no menstrual bleeding.
• Why does it happen? Typically as a normal result of aging, the ovaries stop producing estrogen and progesterone. Most women begin menopause this way naturally as they age. The ovaries can also stop functioning as a result of surgery or medical intervention (i.e. chemotherapy or radiation). In 8% of women, menopause begins in this way.
• The majority of women go through menopause between the ages of 40 and 58. The average age is 51.
• Early onset menopause happens between the ages of 40-45 in about 5% of women and before the age of 40 in 1% of women.
• The transition period leading up to menopause is called perimenopause and often lasts 4-8 years. This is the period where a woman will start experiencing symptoms of menopause, but will still have a menstrual cycle.

The gist, for those of us who like to jump to the nitty gritty: at some point our ovaries will stop making hormones. The effect on our body is noticeable and I’m going to go out on a limb and say, not desired. I am 46 years old and started noticing changes in my body in my early 40s. In fact, a second after I turned 40, I couldn’t read my texts, my low back hurt, gray hair popped up in unmentionable places, not to mention the stray hair protruding from my chin and we have already talked about my night sweats. I cringed at the thought of transitions lenses and cried when I found out my mammogram was abnormal. As I mentioned in my last blog, doctors are human too and not immune to aging.  Needless to say, I’ve adjusted to my new glasses (although the ground seems much higher), survived the diagnostic mammogram and embraced regular waxing.

Every woman is different, but it is rare that I see a woman who has no bothersome symptoms of menopause. Certainly, some women fare better than others, but pretty much all women will experience some pesky symptoms because menopause is inextricably tied to the aging process.

So, what might happen to your body during menopause? Again, every woman’s menopause experience is different, but I can let you in on some hard truths. Warning: the contents below may be a little worrisome. Don’t hate me, I’m just the messenger and if it helps, I’m in the accelerated aging phase too. Hang with me! I promise to discuss treatment options for the physical symptoms of menopause in the next blog.

1. Hot flashes and night sweats are real…how long will they last?!

Over 80% of women experience hot flashes, making it the most common menopausal complaint. These are characterized by a sudden wave of heat triggering sweating, reddening of the skin and racing heart beat that last 1-5 minutes. Hot flashes that occur at night are referred to as night sweats and often result in sleep disturbance. Both hot flashes and night sweats are followed by a cold chill. The number of episodes vary from a few to multiple episodes per day. The highest occurrence is during perimenopause and first 2 years of postmenopause.

The Study of Women’s Health Across the Nation (SWAN) is a large, multiethnic, community based sample of midlife women from across the United States designed to study the menopause transition. Over 3,000 women have been followed annually from 1996. In this large population of diverse women, they found hot flashes persisted for 4.5 years after the last menstrual period for most women; however, African American women experienced symptoms for an additional 2 years (lucky me).

2. Expect the unexpected from your menstrual cycle

Some women are very lucky. Their menstrual cycle gets shorter, lighter, spaces out and eventually just goes away. They have very polite, civilized menstrual cycles. Unfortunately, many women have very rude, unmanageable, inconsiderate cycles. These women will experience heavier, longer, more frequent cycles before they stop. If your cycle lasts more than 7 days, you change your pad more frequently than every 2 hours, you experience flooding through your protection, soil your clothing or pass large blood clots….you are bleeding too heavily and should be evaluated by a health care professional. Even if you don’t feel the flow of your cycle is too heavy, but have an unpredictable pattern of bleeding, you should be evaluated as well. Many may disagree, but I firmly believe menstrual cycles should not negatively impact quality of life. No woman should suffer; there are numerous treatment options.

3. “If I just keep my legs crossed I might not pee in my pants or lose my uterus…”

The bladder, uterus, vaginal walls and rectum are supported and held in place by muscles and very strong tissue called fascia. Just like the muscles all over our bodies, the muscles in the vaginal area weaken as we age. Decreasing estrogen levels add to this effect as well. In some women these muscles weaken so much that they can’t hold the organs in the pelvis anymore. The change in support can affect urinary and bowel function, as well as, result in increased pain and pressure. In extreme cases, the organs can prolapse (drop down) outside of the vagina. All of which can impact daily function including sexual function. I know I said, I wouldn’t discuss treatment until the next blog, but I’m sure a few mouths have dropped. No need to worry there are many effective treatment options. No one should suffer. More in the next blog; however, if you are a woman that is currently dealing with a prolapse issue please see a urogynecologist (a gynecologist who specializes in the care of women with pelvic floor support issues).

4. Weight gain, thinning hair, dry skin and did my knees just crack when I stood up!!?!

Aging is associated with changes in metabolism, decreased muscle mass and increased body fat content. This can be related to menopause specifically, but is often due to a decline in physical activity, which often happens as women age. Weight tends to deposit around the waist and belly creating an apple shape and this has health consequences.

Weight gain increases the risk of diabetes, hypercholesterolemia, cardiovascular disease, osteoarthritis, and certain types of cancer (breast, ovarian, uterine and colon). It can also contribute to reduced mobility, poor self-image and decreased energy. Lack of exercise and poor diet also impacts bone loss and pelvic floor support, which can lead to fractures and pelvic organ prolapse. And no need to wait on my tips for this one! I have already offered tips for how to optimize health and improve overall quality of life. I don’t have the antidote to aging but embracing a regular exercise routine that includes aerobic activity and strength training along with meticulous dietary choices certainly comes close.

5. Sexual dysfunction…opening Pandora’s Box

Intimacy and sexuality are integral to our well-being.  Understanding the cause of sexual issues in women can be complicated, as there are both physical and mental contributing factors. The decrease in estrogen production by the ovaries results in physical changes to the vaginal tissues: thinning, drying and inflammation in varying degrees can occur. Certainly if intercourse is painful, our desire to engage will be low. Unlike hot flashes and night sweats, which improve over time, vaginal symptoms are likely to worsen and do not resolve on their own without treatment.

All of the changes that occur in menopause, in addition to certain medications, surgical treatments, radiation, medical illnesses and history of abuse can negatively impact sexual function. This is the point where many of you may be sighing, don’t fret we are going to discuss ways to improve sexual function through menopause and beyond and already have a couple of blogs throughout the site that might be helpful for you today. Sexual wellbeing is integral to our health and happiness.

Worried yet? Don’t be! Next, I will discuss traditional and holistic approaches to managing these physical symptoms. Get ready to learn more about everything from hormone treatments to the magic of Vaseline. In the meantime, do not forget to send your questions about the effects of menopause and ways to manage menopausal symptoms to info@womanlab.org.

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Edited by Leilani Douglas